Vested interests in addiction research and policy alcohol industry use of social aspect public relations organizations against preventative health measures

Aim It has been proposed that alcohol industry ‘social aspects/public relations’ organizations (SAPROs) serve the agenda of lending credibility to industry claims of corporate responsibility while promoting ineffective industry-friendly interventions (such as school-based education or TV advertising campaigns) and creating doubt about interventions which have a strong evidence base (such as higher taxes on alcoholic beverages). This paper investigated whether submissions to Australia's National Preventative Health Taskforce (NPHT) from alcohol industry bodies regarding the Australian SAPRO, Drinkwise, have used this organization to demonstrate corporate responsibility while promoting industry-friendly interventions.

Method Submissions to the Australian National Preventative Health Taskforce (NPHT) discussion paper Australia, the healthiest country by 2020 (n = 375) were examined to identify those with primary alcohol content. A thematic analysis of the resulting 33 submissions was conducted to determine which organization, institution or individual discussed Drinkwise.

Setting Australia.

Findings Nine of the 33 submissions discussed Drinkwise; all were submitted by the alcohol industry or its affiliates. Every industry submission referred to Drinkwise either as providing evidence of social responsibility or by suggesting the industry-friendly actions of Drinkwise as alternatives to those recommended by the NPHT report.

Conclusions Drinkwise has been used by the alcohol industry to create an impression of social responsibility while promoting interventions that maintain profits and campaigning against effective interventions such as higher taxes on alcohol.

Quantities of foods consumed by 12- to 24-month-old New Zealand children

Aim:  The present study aimed to estimate small, median and large daily quantities of frequently consumed foods and identify which food groups are important sources of key micronutrients for 12- to 24-month-old New Zealand children.

Methods:  A community-based cross-sectional survey was conducted in three cities in the South Island of New Zealand. Healthy toddlers (n = 188) were randomly selected using multistage sampling. Three non-consecutive 1-day weighed food records were collected from each child and the frequencies and daily quantities of foods and beverages, and important sources of iron and zinc, were determined.

Results:  Fifty percent or more of the children consumed the following foods at least once over 3 days (median gram intake among toddlers who consumed the food): milk (366 g), white bread (29 g), banana (70 g), potato (34 g), cheese (12 g), apple (39 g), ‘Weetbix’ whole-wheat breakfast cereal (16 g), yeast extract spread (‘Marmite’, ‘Vegemite’) (2 g), carrot (17 g) and margarine (4 g). Dairy, cereals and the meat/fish/poultry/eggs/nuts food group were the most important sources of iron and zinc in the toddlers' diets, providing 69.1% of iron and 86.3% of zinc.

Conclusion:  This research provides dietitians, other health professionals, researchers and policy-makers with detailed information on daily quantities of foods and beverages frequently consumed by toddlers that can be used for dietetic counselling, dietary assessment, and to develop food-based dietary guidelines specifically for toddlers.

A cluster randomised controlled trial of a comprehensive accreditation intervention to reduce alcohol consumption at community sports clubs: study protocol

Introduction: Excessive alcohol consumption isresponsible for considerable harm from chronicdisease and injury. Within most developed countries,members of sporting clubs consume alcohol at levels above that of communities generally. Despite the potential benefits of interventions to address alcohol consumption in sporting clubs, there have been no randomised controlled trials to test the effectiveness of these interventions. The aim of this study is to examine the effectiveness of a comprehensive accreditation intervention with community football clubs (Rugby League, Rugby Union, soccer/association football and Australian Rules football) in reducing excessive alcohol consumption by club members.
Methods and analysis: The study will be conducted in New South Wales, Australia, and employ a cluster randomised controlled trial design. Half of the football clubs recruited to the trial will be randomised to receive an intervention implemented over two and a half winter sporting seasons. The intervention is based on social ecology theory and is comprehensive in nature, containing multiple elements designed to decrease the supply of alcohol to intoxicated members, cease the provision of cheap and free alcohol, increase the availability and costattractiveness of non-alcoholic and low-alcoholic beverages, remove high alcohol drinks and cease drinking games. The intervention utilises a three-tiered accreditation framework designed to motivate intervention implementation. Football clubs in the control group will receive printed materials on topics unrelated to alcohol. Outcome data will be collected pre- and postintervention through cross-sectional telephone surveys of club members. The primary outcome measure will be alcohol consumption by club members at the club, assessed using a graduated frequency index and a seven day diary.
Ethics and dissemination: The study was approved by The University of Newcastle Human Research Ethics Committee (reference: H-2008-0432). Study findings will be disseminated widely through peer-reviewed publications and conference presentations.

Influences on consumption of soft drinks and fast foods in adolescents

Soft drink and fast food are energy dense foodstuffs that are heavily marketed to adolescents, and are likely to be important in terms of risk of obesity. This study sought to examine the influences on soft drink and fast food consumption among adolescents as part of a cross-sectional survey of 2,719 adolescents (aged 11-16) from 93 randomly selected schools in New South Wales, Australia. Students provided information on soft drink and fast food consumption, and responded to statements examining influences over consumption. Over half of the boys and more than one third of the girls reported drinking soft drink daily, and consumption peaked in Grade 8 students. A quarter of students reported choosing soft drinks instead of water or milk, and around 40% agreed that soft drink was usually available in their homes. Availability in the home and drinking soft drinks with meals was most strongly associated with consumption in all age groups. Fast food consumption was higher among boys than girls in all age groups. Convenience and value for money yielded the strongest associations with fast food
consumption in boys, while preferring fast food to meals at home and preferring to “upsize” meals were most strongly associated with consumption in girls. Interventions to reduce consumption of soft drinks should target availability in both the home and school environment by removing soft drinks and replacing them with more nutritive beverages. Fast food outlets should be encouraged to provide a greater range of healthy and competitively priced options in reasonable portions.

Children's consumption of energy dense nutrient poor foods, fruit and vegetables; are they related? An analysis of data from a cross sectional survey

Issue addressed: Many children consume excessive amounts of energy-dense, nutrient-poor (EDNP) or 'extra' foods and low intakes of fruit and vegetables. The aim of this study was to examine the associations between EDNP foods and ascertain whether certain EDNP foods and beverages are more likely to be eaten in association with other EDNP foods.

Methods: A cross-sectional representative population survey of children in preschool (n=764), and of school students in Years K, 2 and 4 (n=1,560) and in Years 6, 8 and 10 (n=1,685) residing in the Hunter New England region of New South Wales, Australia. Dietary data were collected using a short food frequency questionnaire. Multivariate logistic regression models examined the association between EDNP foods and fruit and vegetable intake. Data were stratified by sex and age cohort.

Results: More frequent consumption of some EDNP food types was significantly associated with more frequent consumption of other EDNP foods. Fast food and soft drinks consumption were associated with each other as well as with fried potato and salty snacks; and with lower intakes of fruit and vegetables in some but not all age groups.

Conclusion: The positive associations found between EDNP foods point towards the existence of a high-risk group of children who frequently consume a variety of EDNP foods and drinks.

The acute effects of caffeine in a sugar-sweetened beverage on energy consumption

Background: It has been suggested that those who are habitually high caffeine consumers ingest greater quantities of snack foods both in and outside the laboratory. Sugar-sweetened beverages (SSBs) are a major contributor to caffeine consumption and evidence links SSB consumption with poor dietary intake.

Objective: To determine whether varying the concentration of caffeine in SSBs influences snack food consumption and energy intake.

Methods: Caffeine taste thresholds were assessed using the International Standards Organization method for assessing taste sensitivity. In a crossover study design, participants (n=23, 26±5 years old, 58% female) were provided with a standardized meal on 4 days and simultaneously consumed SSBs with varied levels of caffeine (0, 0.67, 1.16, and 1.65 mM). The intake of food and beverage was recorded following each meal session.

Results: A one way between groups analysis of variance revealed no significant main effect of caffeine concentration on consumption of SSBs [F (3, 92)=0.154, p=0.927] or food [F (3, 92)=0.305, p=0.822]. Pearson correlation analysis identified no significant correlations between the amount of food and SSB consumed (R=−0.031–0.415, p=0.062–0.893), or the amount of food and SSB consumed with body mass index and waist circumference (R=0.000 to −0.380, p=0.073–0.999). An individual's oral sensitivity to caffeine was not associated with SSB consumption (R=0.045 to −0.309, p=0.152–0.839) or the consumption of food (R=−0.052 to −0.327, p=0.128–0.812).

Conclusions: The concentration of caffeine in SSBs did not influence the amount of food or SSB consumed.

Dietary sodium intake is associated with total fluid and sugar-sweetened beverage consumption in US children and adolescents aged 2 - 18 y : NHANES 2005 - 2008

Background: Increasing dietary sodium drives the thirst response. Because sugar-sweetened beverages (SSBs) are frequently consumed by children, sodium intake may drive greater consumption of SSBs and contribute to obesity risk.

Objective: We examined the association between dietary sodium, total fluid, and SSB consumption in a nationally representative sample of US children and adolescents aged 2–18 y.

Design: We analyzed cross-sectional data from NHANES 2005–2008. Dietary sodium, fluid, and SSB intakes were assessed with a 24-h dietary recall. Multiple regression analysis was used to assess associations between sodium, fluid, and SSBs adjusted for age, sex, race-ethnic group, body mass index (BMI), socioeconomic status (SES), and energy intake.

Results: Of 6400 participants, 51.3% (n = 3230) were males, and the average (±SEM) age was 10.1 ± 0.1 y. The average sodium intake was 3056 ± 48 mg/d (equivalent to 7.8 ± 0.1 g salt/d). Dietary sodium intake was positively associated with fluid consumption (r = 0.42, P < 0.001). After adjustment for age, sex, race-ethnic group, SES, and BMI, each additional 390 mg Na/d (1 g salt/d) was associated with a 74-g/d greater intake of fluid (P < 0.001). In consumers of SSBs (n = 4443; 64%), each additional 390 mg Na/d (1 g salt/d) was associated with a 32-g/d higher intake of SSBs (P < 0.001) adjusted for age, sex, race-ethnic group, SES, and energy intake.

Conclusions: Dietary sodium is positively associated with fluid consumption and predicted SSB consumption in consumers of SSBs. The high dietary sodium intake of US children and adolescents may contribute to a greater consumption of SSBs identifying a possible link between dietary sodium intake and excess energy intake.

Monitoring food and non-alcoholic beverage promotions to children

Food and non-alcoholic beverage marketing is recognized as an important factor influencing food choices related to non-communicable diseases. The monitoring of populations' exposure to food and non-alcoholic beverage promotions, and the content of these promotions, is necessary to generate evidence to understand the extent of the problem, and to determine appropriate and effective policy responses. A review of studies measuring the nature and extent of exposure to food promotions was conducted to identify approaches to monitoring food promotions via dominant media platforms. A step-wise approach, comprising ‘minimal’, ‘expanded’ and ‘optimal’ monitoring activities, was designed. This approach can be used to assess the frequency and level of exposure of population groups (especially children) to food promotions, the persuasive power of techniques used in promotional communications (power of promotions) and the nutritional composition of promoted food products. Detailed procedures for data sampling, data collection and data analysis for a range of media types are presented, as well as quantifiable measurement indicators for assessing exposure to and power of food and non-alcoholic beverage promotions. The proposed framework supports the development of a consistent system for monitoring food and non-alcoholic beverage promotions for comparison between countries and over time.

Components of the diet associated with child adiposity: a cross-sectional study

Objective:
This study sought to determine which components of youths' diets were related to adiposity while controlling for potential often-neglected confounders such as moderate to vigorous physical activity (MVPA) and dietary reporting error. Secondary goals of this study were to determine the extent to which MVPA confounded the associations between diet and adiposity and whether associations between diet and adiposity would differ depending on reporting error.

Methods:
An ethnically diverse urban sample of 342 children aged 9–10 years and 323 adolescents aged 17–18 years were recruited for this cross-sectional study. Body mass index (BMI) and waist circumference (WC) were measured in the school; dietary assessment included three 24-hour recalls via telephone in the evenings, and MVPA assessment included 5 days of accelerometry. Over (n = 68), under (n = 250), or plausible (n = 347) dietary intake reporters were identified with the Huang calculation method. Linear regression assessed the relationship between adiposity indicators (BMI z-score and WC) and components of the diet (energy intake, food groups, macronutrients) after controlling for reporting error, demographic variables, and MVPA.

Results:
When dietary reporting error and potential confounders such as MVPA and demographic variables were controlled, energy intake (EI), vegetables, refined grains, total fat, total protein, and total carbohydrate were positively related to BMI z-score and WC and artificially sweetened beverages to WC. MVPA was a significant confounder. For BMI z-score, but not WC, relationships and strength of these relationships differed depending on dietary reporting error group (plausible, underreporter, overreporter).

Conclusions:
Among plausible reporters, as expected, EI, refined grains, and all macronutrients were positively related to adiposity; however, artificially sweetened beverages and vegetables, which are low-energy-dense foods, were also positively related to adiposity. Reporting error interfered with associations between diet and BMI z-score but not WC, suggesting WC is a more robust measure of adiposity in relation to diet.

Considerations for the use of salivary IgA for monitoring mucosal immune function

Introduction: 

Dietary salt intake in Australian and US children and adolescents

Dietary salt intake in Australian children exceeds recommendations and children of lower socioeconomic background consume even greater quantities. In Australian and US children, salt intake was positively associated with sugar-sweetened beverages, indicating a potential link between salt intake and obesity. Public health strategies to reduce salt intake in Australian children are required.